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Arthritis supplements

Last night I went to a presentation on arthritis and its treatment, put on by my vets at a local hotel. It included information on acupuncture, hydrotherapy and physiotherapy as well as veterinary treatment options (it also included drinks and nibbles!). We were given a goody bag to take home, which included samples of EaseFlex Plus, a supplement to reduce stiffness and maintain mobility. The main ingredients are glucosamine, chondroitin and green-lipped mussel. I wondered if it would help my Oliver, who has spondylosis. He takes a Carprieve tablet every day, which has greatly helped his mobility, but is still stiff in the mornings and quite wobbly for a little while after he gets up. Has anyone got experience of this kind of supplement? I can vaguely remember a thread a couple of years ago that said that once arthritis has set in, giving this sort of supplement isn't much help - it's more useful as a preventive, but I may be remembering that wrong. I'm not really very keen on giving Oliver something else to take on top of Carprieve, his SM drug, and ointment for his dry eye, but if this EaseFlex would really help, it would be worth considering.

Some research indicates that glucosamine is possibly best to take when younger -- BUT there is also a huge recent US study of thousands of individuals that indicated it really doesn't do anything at all (nor chondroitin etc). That said a very eminent retired California orthopedist and sports medicine specialist who is a family friend strongly believes in these supplements and takes them daily for joint health. So I guess the answer is there's no clear evidence they help; there's some pretty convincing evidence they may be a waste of money; but some experts disagree with that evidence. Easeflex wouldn't really have anything that would be unwanted.

What do others think? Any improvement in your dogs (or you!) on these kinds of supplements?

On arthritis -- having this myself in one form, I can say morning stiffness is pretty common for all forms of arthritis whether muscular or joint related, and that what helps most is getting up and getting the joints working -- that's why dogs and people generally feel much better a little later in the day. Also -- can state very strongly that exercise generally really helps the condition overall and not moving makes it worse; so would not discourage walks etc in an arthritic dog, just take it easy. Discomfort can make people and animals reluctant to move but unless there's extreme pain, not moving only adds to the overall problem.

My girls have been on Easeflex plus for at least 4 years plus they all have half a "plug" every morning .I think it comes in tubs of 120 and cost around
£45.00 so a tub lasts for me about two months but of course I cant comment on its effectiveness as I have been giving it as a preventive product .

Kate, here's a summary of existing research -- conclusion is this type of supplement likely doesn't do anything -- and chondroitin in particular is a waste of money (supplements of only glucosamine are much cheaper; good to shop around. Dogs can take the human supplements and they tend to be cheaper as well). There have been some rare health issues from taking it including possibly a death. But opinions do vary on using it! :

Osteoarthritis (OA), the most widespread type of arthritis, is a degenerative disease of the joints. Although sometimes capable of causing acute inflammation, it is most commonly a "wear-and-tear" disease involving degeneration of joint cartilage and formation of bony spurs within various joints. Trauma to the joints, repetitive occupational usage, and obesity are risk factors. Most people over 60 years of age have this affliction to some extent, with approximately 16 million sufferers requiring medical care. The main goal of treatment is to relieve pain.

Glucosamine and chondroitin have been widely promoted as a treatment for OA. Glucosamine, an amino sugar, is thought to promote the formation and repair of cartilage. Chondroitin, a carbohydrate, is a cartilage component that is thought to promote water retention and elasticity and to inhibit the enzymes that break down cartilage. Both compounds are manufactured by the body. Glucosamine supplements are derived from shellfish shells; chondroitin supplements are generally made from cow cartilage.

Research Findings

Laboratory studies suggest that glucosamine may stimulate production of cartilage-building proteins. Other research suggests that chondroitin may inhibit production of cartilage-destroying enzymes and fight inflammation too. Some human studies have found that either one may relieve arthritis pain and stiffness with fewer side effects than conventional arthritis drugs. Other studies have shown no benefit. As the research accumulated, expert review bodies have been cautious because, although positive reports outnumbered negative ones, the negative ones have been larger and better designed [1]. In addition, whether glucosamine offers any advantages over established drugs such as acetaminophen, traditional NSAIDS, or selective Cox-2 inhibitors has not been determined [2].

The largest and best-designed clinical trial is the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), which is funded by the National Institutes of Health. So far, the GAIT has produced two sets of negative results. In 2006, the researchers reported on a 24-week study that involved 1583 patients who were randomly assigned to receive 500 mg of glucosamine hydrochloride three times daily, 400 mg of sodium chondroitin sulfate three times daily, 500 mg of glucosamine plus 400 mg of chondroitin sulfate three times daily, 200 mg of celecoxib (Celebrex) daily, or a placebo. The study found that glucosamine and chondroitin, alone or together, did not reduce osteoarthritis knee pain more effectively than a placebo. The drug group did about 17% better than the placebo group [3].

The above-mentioned report was accompanied by an editorial which concluded:

[Based on this study], it seems prudent to prudent to tell our patients with symptomatic osteoarthritis of the knee that neither glucosamine hydrochloride nor chondroitin sulfate alone has been shown to be more efficacious than placebo for the treatment of knee pain. If patients choose to take dietary supplements to control their symptoms, they should be advised to take glucosamine sulfate rather than glucosamine hydrochloride and, for those with severe pain, that taking chondroitin sulfate with glucosamine sulfate may have an additive effect. Three months of treatment is a sufficient period for the evaluation of efficacy; if there is no clinically significant decrease in symptoms by this time, the supplements should be discontinued. Furthermore, there is no evidence that these agents prevent osteoarthritis in healthy persons or in persons with knee pain but normal radiographs [4].

In 2007, another well-designed study that involved 71 patients with osteoarthritis of the knee who were followed for one year. The study found no significant differences in function and pain between the treatment and placebo groups [5]. Later that year, a meta-analysis concluded: "Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged." [6]

To study whether the glucosamine and/or chondroitin could diminish the structural damage of osteoarthritis, interested GAIT patients were offered the opportunity to continue their original study treatment for 18 more months, for a total of two years [7]. About 570 patients enrolled. In 2008, the researchers reported that none of the treatment groups showed a significant structural benefit (slowing of the narrowing of the joint space). The researchers expressed hope that additional research might find that an as-yet-undefined subgroup of patients can benefit, but I don't share their optimism.

Two studies reported in 2010 found that patients with chronic pain experienced no benefit from taking 1500 mg/day of glucosamine. One study involved 250 adults with chronic low-back pain and degenerative osteoarthtiris who were followed for one year. Half of the patients took glucosamine and half received a placebo. The glucosamine group did no better than the placebo group [8]. The other study involved 662 GAIT participants with moderate-to-severe knee osteoarthritis who received either glucosamine (500 mg three times daily), chondroitin sulfate (400 mg three times daily), glucosamine and chondroitin sulfate combined (same doses), celecoxib (Celebrex, 200 mg once daily), or a placebo. There were no statistically significant differences among the groups [9].

Products

In the United States, glucosamine and chondroitin products are marketed as "dietary supplements." Glucosamine is available in many forms, including glucosamine sulfate, glucosamine hydrochloride (HCl), and N-acetylglucosamine (NAG), and may also contain a potassium chloride or sodium chloride salt. However, there appears to be no conclusive evidence that one form is better than another. Chondroitin is typically sold as chondroitin sulfate.

In December 1999 and January 2000, ConsumerLab.com tested 25 brands of glucosamine, chondroitin and combination products and found that (a) all 10 glucosamine-only products, passed the test but 2 chondroitin-only and 6 out of 13 combination products did not (because their chondroitin levels were too low). In January 2001, one of the combination products was removed because its manganese level was judged to be too high [10]. ConsumerLab's latest report states that 8 out of 8 tested glucosamine products contained the label amount but 2 of 2 chondroitin products did not [11].

In 2001, Consumer Reports evaluated 19 products and reported:

Most . . . were reasonably well standardized, delivering at least 90 percent of the amount of glucosamine or chondroitin promised on the label, thereby meeting a new standard for the supplements proposed by the U.S. Pharmacopeia, which sets standards for drugs and proposes them for supplements. But four products —Now Double Strength Glucosamine & Chondroitin, ArthxDS Glucosamine Chondroitin, Solgar Extra Strength Glucosamine Chondroitin Complex, and Now Chondroitin Sulfate—failed to meet that standard. Two products—Solgar Extra Strength Glucosamine Chondroitin Complex and Twinlab CSA (Chondroitin Sulfate)—recommended too few pills per day to supply the dose used in the successful clinical trials. Several others listed the recommended number of pills as a range that permits consumers to take a dose that may be inadequate [12].

Safety Considerations

No study so far has found any serious side effects from either glucosamine or chondroitin. The most common side effects are increased intestinal gas and softened stools. However, animal research has raised the possibility that glucosamine may worsen insulin resistance, a major cause of diabetes. So far, studies in humans have not substantiated that risk. Nevertheless, people with diabetes should monitor their blood-sugar level particularly carefully when using that supplement. There have been no reports of allergic reactions to glucosamine. But because it is made from shellfish shells, people who are allergic to seafood should use it cautiously, watching for reactions, or avoid it entirely. As for chondroitin, it can cause bleeding in people who have a bleeding disorder or take a blood-thinning drug.

In 2001, Vital Nutrients recalled two products (Vital Nutrients Joint Ease and Verified Quality Joint Comfort) that had been found to contain aristolochic acid, a substance that can cause kidney toxicity and cancer [13].

In 2008, a Scottish newspaper reported that people had died of liver failure within weeks of taking glucosamine [14]. Although cause-and-effect cannot be proven, local physicians issued a warning.

The Bottom Line

Chondroitin appears to be useless. Whether glucosamine is useful is conflicting, but the best-designed studies are negative. This usually means that negative evidence will eventually prevail. Decisions to use glucosamine must be based on information that is less complete than is desirable. In addition, product quality control may be a significant problem. Here's my advice:

The first step in seeking care for arthritic symptoms should be to obtain a competent diagnosis.
The next step should be to explore the pros and cons of treatment options with a competent physician.
If you decide to try glucosamine anyway, have a knowledgeable physician guide how you do it. Consumer Reports, ConsumerLab.com, or your physician can help in choosing the product.
Regard chondroitin as worthless.
Ignore any practitioner or seller who promises a "miracle cure" for arthritis.
Never buy a dietary supplement in response to a solicitation by mail or though s radio or television ad.
Shop carefully for price. The Puritan's Pride mail-order division, which has frequent "2-for-1" and "3-for-one" sales, sells products that cost only $4 to $5 per month. (Be sure, of course, to ignore claims the company makes for its products. No seller of dietary supplements, herbs, or homeopathic remedies should be trusted for advice on whether they are useful.)
References

Thanks for the info, Karlin - that was more or less what I'd remembered from the previous thread. What helps Oliver as much as anything is a good rub round his hindquarters before he gets up in the morning, and after a few wobbly minutes he's quite active for the rest of the day and happily walks a couple of miles, at least some of it trotting around off-lead. I didn't really take much notice of the fact that he has almost always paced until he started taking Rimadyl then Carprieve as part of the RVC clinical trial of CM/SM medicines earlier this year, when he suddenly started trotting happily.

I think I'll give EaseFlex a miss - especially as I looked on Hyperdrug (usually a good price) and found a tub of 120 chews (admittedly, 6 months' supply for one dog of Oliver's weight) was nearly £70! The mainstream medication that Oliver's on does him pretty well, and I don't really see the point of supplements unless they are proven to make a real difference.

I have used both ie Easeflex plus and Easeflex and they are basically the same but the prices do vary considerably on the Internet .Hyperdrug
for Easeflex 120 chews is £61.79 while Animed Direct charge £45.60 and if I remember you give one chew for the first month then half a chew
going forward so a tub of 120 lasts my four girls two months at a cost of £45.60.